Urinary diversion via a continent ileal reservoir in the abdominal cavity has been previously performed, see for instance:
(I) Urinary diversion via a continent ileal reservoir: Clinical results in 12 patients, N. G. Kock, A. E. Nilson, L. O. Nilsson, L. J. Norlen and B. M. Philipson; The Journal of Urology, Vol. 128. Sept 1982, and PA0 (II) Current Status of the Ileal Reservoir for Continent Urinary Diversion, N. G. Kock, L. Norlen, B. M. Philipson and S. .ANG.kerlund: Surgical Rounds, Jan. 1985, p. 32-48.
For construction of the ileal reservoir (Kock reservoir) a small bowel segment is isolated from the intestinal canal and used for the reservoir walls. The operative technique for this is previously known, see ref. I-II, and will therefore not be described in detail here.
The completed ileal reservoir is made with a reflux valve nipple (inlet opening) and a continence valve nipple (outlet opening). Both these valves are formed by a surgical technique in which an ileum segment is folded into a U-shape directed towards the interior of the reservoir and preformed into small inlet and outlet channels. Also the technique for forming these nipple valves is described in the references I-II.
The position and form of the valve nipples are not always maintained, however. In the long run an eversion and relapse may occur which means a malfunction of the valve nipples with respect to the inlet and outlet control of the reservoir.
In order to prevent such eversion of the valve nipples it is previously known to stabilize the valve nipples by means of staples applied by a stapling instrument so that the folded tissue is clamped together. The staples can be made of an absorbable or biocompatible material such as titanium. The valve nipples are secured by such staples, but as the staples penetrate the reservoir wall it involves a risk for the formation of stones in the urine when the contents of the reservoir is infected. Furthermore it is an expensive method as four rows of staples are applied around the nipple valve by use of a specific stapling instrument having fastener and retainer parts as well as a loading unit for the staples.
It is also previously known to stabilize the valve nipples by means of a Marlex mesh, that is, a strip of a synthetic mesh-like material positioned around the base of the nipple valves and sutured together to prevent desusception of the nipple valves but not so tight that urinary flow is obstructed. The Marlex mesh strips are applied exterior to the reservoir around the base of the nipple valves. However, the Marlex mesh may still irritate the surrounding tissue and cause fistulation and later on formation of stones in the urine.